Cholesteatoma

A type of skin growth in the middle ear behind the eardrum

Cholesteatoma
Synonyms	Epidermoid cyst of the middle ear
Pronounce	N/A
Field	N/A
Symptoms	Hearing loss, ear discharge (otorrhea), ear fullness, vertigo, tinnitus, facial nerve palsy
Complications	Chronic ear infections, facial nerve damage, labyrinthitis, brain abscess, meningitis, mastoiditis
Onset	Usually gradual
Duration	Chronic if untreated
Types	Congenital, Acquired (primary or secondary)
Causes	Eustachian tube dysfunction, chronic otitis media, congenital epithelial inclusion
Risks	Chronic otitis media, recurrent ear infections, eustachian tube dysfunction, cleft palate
Diagnosis	Otoscopy, CT scan of temporal bone, audiometry, MRI
Differential diagnosis	Otitis media, aural polyp, glomus tumor, external auditory canal cholesteatoma
Prevention	Timely treatment of middle ear infections, proper ear hygiene, surgical repair of eardrum perforations
Treatment	Surgical removal (e.g., mastoidectomy, tympanoplasty)
Medication	Antibiotic ear drops for secondary infection; pain management
Prognosis	Good with complete surgical excision; risk of recurrence if incomplete removal
Frequency	~9 per 100,000 adults; ~3 per 100,000 children annually
Deaths	Rare with timely treatment; severe cases may result in fatal intracranial complications

A cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle section of the ear, behind the eardrum. It can be congenital (present at birth) or acquired, often as a result of repeated ear infections.

Pathophysiology

Cholesteatomas occur when skin cells accumulate in the middle ear. This can happen due to a perforated eardrum or a dysfunction of the Eustachian tube, which can lead to negative pressure in the middle ear. This negative pressure can cause a retraction pocket in the eardrum, where skin cells can collect and form a cholesteatoma.

Symptoms

The symptoms of a cholesteatoma can vary but often include:

• Hearing loss
• Ear drainage
• Ear pain
• A feeling of fullness in the ear
• Dizziness or vertigo
• Tinnitus (ringing in the ear)

If left untreated, a cholesteatoma can lead to more serious complications, such as:

• Chronic ear infections
• Facial muscle paralysis
• Meningitis
• Brain abscess

Diagnosis

Diagnosis of a cholesteatoma typically involves a thorough examination by an otolaryngologist (ear, nose, and throat specialist). This may include:

• Otoscopy to examine the ear canal and eardrum
• Audiometry to assess hearing loss
• CT scan or MRI to evaluate the extent of the cholesteatoma and any potential damage to surrounding structures

Treatment

The primary treatment for a cholesteatoma is surgical removal. The goal of surgery is to remove the cholesteatoma and prevent complications. Surgery may involve:

• Mastoidectomy to remove the cholesteatoma and any infected tissue
• Tympanoplasty to repair the eardrum and restore hearing

Post-surgery, patients may require regular follow-up visits to monitor for recurrence, as cholesteatomas can recur even after successful removal.

Prevention

Preventing cholesteatomas involves managing risk factors such as chronic ear infections and Eustachian tube dysfunction. This may include:

• Treating ear infections promptly
• Managing allergies or sinus infections
• Avoiding smoking and exposure to secondhand smoke

Related pages

• Otitis media
• Eustachian tube dysfunction
• Hearing loss
• Tympanoplasty

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